世界銀行-加勒比監(jiān)管體系：有效藥品注冊和警戒的分區(qū)域辦法（英）

A

PublicDisclosureAuthorizedPublicDisclosureAuthorizedPublicDisclosureAuthorizedPublicDisclosureAuthorized

CARPHACaseStudy

TheCaribbeanRegulatorySystem

ASubregionalApproach

forE?cientMedicine

RegistrationandVigilance

HuihuiWang

AlbertFigueras

RianMarieExtavour

PatricioV.Marquez

KseniyaBieliaieva

WiththeguidanceofJoySt.John,

ExecutiveDirector,CARPHA

Korea-WorldBankPartnershipTrustFund(KWPF)

BTheCaribbeanRegulatorySystem:ASubregionalApproachforEfficientMedicineRegistrationandVigilance

?2023InternationalBankforReconstructionandDevelopment/TheWorldBank

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TheCaribbeanRegulatorySystem

ASubregionalApproachfor

EfficientMedicineRegistration

andVigilance

iiTheCaribbeanRegulatorySystem:ASubregionalApproachforEfficientMedicineRegistrationandVigilance

Tableof

Contents

ReportsinthePharmacovigilanceand

EssentialPublicHealthServicesSeries iv

Acronyms

v

Acknowledgements vi

1.Introduction 1

1.1.Background 1

1.2.TheglobalburdenofdiseaseintheCaribbean 3

2.TheCaribbeanPublicHealthAgency 6

2.1.CARICOMgoverningbodies 6

2.2.TheCaribbeanCooperationinHealth 6

2.3.ThecreationoftheCaribbeanPublicHealthAgency 7

3.CaribbeanRegulationofMedicines:ASmall-StateSolution 11

3.1.CRSpilotinitiative:importantdesignelements 11

3.2.EvaluationoftheCaribbeanRegulatorySystemmedicinesreviewprocess 13

3.3.Challenges 15

4.VigiCarib:TheExperienceofaRegionalPVSystem 16

4.1.PharmacovigilanceintheCaribbean 17

4.2.Missionandobjectives 18

4.3.Prerequisites 18

4.4.Initialactivities 19

4.5.Communicationtools 19

4.6.Results 19

5.SomeLessonsLearned 22

References 23

TableofContentsiii

Boxes

Box1.

TheNoncommunicableDiseaseBurdenintheCaribbean

ExplainedinNumbers 5

Box2.PromotingandStrengtheningtheCaribbeanRegulatorySystem 9

Box3.

ReviewofMedicines 14

Box4.

ReportsofAEFIswithCOVID-19Vaccines 21

Figures

Figure1.TheproportionofallcausesofdeathindifferentCaribbean

countriesandtheoverallproportioninLatinAmericaand

Caribbeancountries(LAC32) 4

Figure2.RegionalHealthInstitutionsMergedintheCaribbeanPublic

HealthAgency,2013 8

FigureB2.1.TheFourDimensionsandComponentsofMedicineRegulation 9

Figure3.CARPHAUnitssupportingRegulationofMedicalProducts 12

Figure4.MarketSurveillanceandControlandPharmacovigilance

Activities 16

Figure5.TheDistributionofVigiCaribCaseReports,

November2017–July2022 20

FigureB4.1.TrendsinSeriousandNonseriousReports,

March2021–December2022 21

Tables

Table1.SelectedDemographic,Geographic,andSocioeconomic

Indicators:CARICOM 3

TableB2.1.PrioritiesinMedicineRegulationIdentifiedatthe2009

BarbadosWorkshop 10

Table2.CaseReports,SuspectedAdverseDrug

Reactions,CARICOM,2007–22 20

TableB4.1.TheDistributionofAEFIs,March2021–December14,2022 21

ivTheCaribbeanRegulatorySystem:ASubregionalApproachforEfficientMedicineRegistrationandVigilance

ReportsinthePharmacovigilanceand

EssentialPublicHealthServicesSeries

Global

SynthesisReportonPharmacovigilance:WhyistheSafetyof

MedicinesImportantforResilientHealthSystems?

PositioningReportonPharmacovigilance:TheValueof

PharmacovigilanceinBuildingResilientHealthSystemsPost-COVID

PharmacovigilanceSituationAnalysisReport:SafetyMonitoringof

MedicinesandVaccines

Regional

RealizingaRegionalApproachtoPharmacovigilance:AReviewof

theEuropeanUnionApproach

TheCaribbeanRegulatorySystem:ASubregionalApproachfor

EfficientMedicineRegistrationandVigilance

FinancingofEssentialPublicHealthServicesintheCaribbeanRegion

CountryScope

LearningfromtheRepublicofKorea:BuildingHealthSystem

Resilience

LearningfromBestPractices:AnOverviewoftheRepublicofKorea

PharmacovigilanceSystem

PharmacovigilanceinBrazil:CreatinganEffectiveSystemina

DiverseCountry

StartingandStrengtheningaNationalPharmacovigilanceSystem:

TheCaseofCatalanRegionalActivitiesthatPropelledtheSpanish

PharmacovigilanceSystem

Ghana’sPharmacovigilanceExperience:FromVerticalProgram

ActivitytoNationwideSystem

Acknowledgementsv

Acknowledgements

ThisreportwaspreparedbyateamledbyHuihuiWang(SeniorHealthEconomist,

WorldBankGroup(WBG),includingAlbertFigueras(Consultant,WBG),RianMarie

Extavour(ProgramManager,CaribbeanPublicHealthAgency(CARPHA),PatricioV

Marquez(Consultant,WBG),andKseniyaBieliaieva(Consultant,WBG).

Dr.JoyStJohn,ExecutiveDirector,CaribbeanPublicHealthAgency(CARPHA)and

Co-Chair,TechnicalAdvisoryCommittee,PandemicFund,kindlyreviewedand

providedstrategicguidancethroughoutthepreparationofthereport.

RobertZimmermann(Consultant,WBG)kindlyreviewedandeditedthedraftreport.

JuanPabloUribe,GlobalDirectoroftheWBG’sHealth,NutritionandPopulation|

Director,GlobalFinancingFacility(GFF),andMoniqueVledder,PracticeManager,

HHNGE,WBG,providedstrategicguidanceduringthepreparationofthereportson

pharmacovigilanceandessentialpublichealthservicesthatformthiscollection.

DesignandlayoutforthereportwascreatedbySpaethHill.

Thepreparationofthisreportwascarriedoutunderthesupportprovidedbythe

Korea-WorldBankPartnershipTrustFund(KWPF).

Washington,D.C.July18,2023

viTheCaribbeanRegulatorySystem:ASubregionalApproachforEfficientMedicineRegistrationandVigilance

Acronyms

ADR

AdverseDrugReaction

AEFI

AdverseEventFollowingImmunization

CAREC

CaribbeanEpidemiologyCenter

CARPHA

CaribbeanPublicHealthAgency

CARICOM

CaribbeanCommunity

CCH

CaribbeanCooperationinHealth

CEHI

CaribbeanEnvironmentalHealthInstitute

CFNI

CaribbeanFoodandNutritionInstitute

CHRC

CaribbeanHealthandResearchCouncil

CMN

Communicable,maternal,andnutritionconditions,includingperinatalconditions

CMS

CARPHAMemberStates(inclusiveofCARICOM)

CRDTL

CaribbeanRegionalDrugTestingLaboratory

CRS

CaribbeanRegulatorySystem

GDP

GrossDomesticProduct

GNI

GrossNationalIncome

LAC

LatinAmericanandCaribbeancountries

MQCSD

MedicinesQualityControlandSurveillanceDepartment

NCD

Noncommunicabledisease

NMRA

NationalMedicinesRegulatoryAuthority

PAHO

PanAmericanHealthOrganization

PMS

Postmarketingsurveillance

PV

Pharmacovigilance

WHO

WorldHealthOrganization

viiTheCaribbeanRegulatorySystem:ASubregionalApproachforEfficientMedicineRegistrationandVigilance

Overview

■Amongsmallcountrieswithlimitedresources,lowhealthexpenditure,andfewhealthcareprofessionalstrainedinpharmacovigilance(PV),investmentintheregularmonitoringofthesafetyofthemedicinesusedbythepublicmaynotbepossible.Nonetheless,PV,includingthesurveillanceofadversereactionstomedicinesandvaccinesandtheidentificationofsubstandardorfalsifiedproducts,isanimportantpillarofresilientpublichealth.

■Inthiscase,aregionalapproachmaybeausefulandefficientsolution.Therationaleforaregionalapproachisthat,becauseofthepoolingofresources,thesharingofinformation,andthecoordinationofactivities,efficienciesofscalecanbegainedthatcanleadtostrongersystemsoverall.

■TheCaribbeanPublicHealthAgency(CARPHA),oneofthethreemulti-nationalpublichealthagenciesintheworld,commencedoperationsonJan1,2013,withtheaimofdeliveringthefunctionsoffivepreviousregionalhealthinstitutionsthroughoneplatformforgreatersynergyandcost-effectivenessandastheprincipalinstitutionalexpressionofCaribbeanCooperationinHealth.

■TheactivitiesofCARPHAincludetheprovisionofasubregionalmechanismthatsupportsregulatoryactiontoensureaccesstosafemedicines,suchasthesubregionalsystemforreportingadversedrugreactions(ADRs)andsubstandardandfalsifiedproducts(VigiCarib)undertheCRS,andtheregionalpostmarketingdrugqualitytestingprogramundertheCARPHAMedicinesQualityControlandSurveillanceDepartment.AnotherrelevantCARPHAactivityisreviewingnewmedicineswhich

wanttoentertheCaribbeanmarket.ThiswasespeciallyimportantduringtheCOVID-19pandemic,withtheplethoraofnewvaccines.

■VigiCaribisagoodexampleofasubregionalapproachtofacilitatewell-functioningpostmarketingmonitoringactivities,includingPV.Althoughthisisarelativelynewprogram,itiswellestablished,integrateslessonsfrommoreexperiencedregulatoryauthorities,andsupportssmalleconomieswithoutspecificPVprograms,thushelpingensurethesafety,quality,andeffectivenessofmedicinesandvaccines.

■Overall,VigiCaribcanserveasamodelinotherpartsoftheworldwherearegionalapproachtostrengtheningregulatorysystemsisunderconsideration.However,akeylessonoftheexperienceofCARICOM,isthatregionalinitiativesarecomplexandrequireclearobjectives,harmonization,respectfortheindividualcountriesandterritories,andmutualtrust.

1.Introduction

1.Introduction1

TheVigiCaribcasestudy oftheCaribbeanPublicHealthAgency(CARPHA) canserveasamodelinotherpartsoftheworld

1.1.Background

TheCaribbeanCommunity(CARICOM)isagroupingof20economies:15membersand5associatemembers.Itrepresentsanestimatedpopulationof17million(60percentofwhomareagesunder30)inseveralmainethnicgroups,thatis,IndigenousPeoples,Africans,Indians,Europeans,Chinese,Portuguese,andJavanese.Itisamultilingualcommunity.Englishisthemajorlanguage,comple-mentedbyFrench,Dutch,andvariationsofthese,aswellasAfricanandAsianlanguagesanddialects.1CARICOMstretchesfromTheBahamasinthenorthtoSurinameandGuyanainSouthAmerica(map1).WiththeexceptionofBelize,inCentralAmerica,andGuyanaandSuriname,inSouthAmerica,allmembersandassociatesareislandeconomies.

1“WhoWeAre,”CARICOM,Georgetown,Guyana,

/

our-community/who-we-are/

.

ThehistoryoftheCaribbeanCommunityisquitelong.ItiswidelyacceptedthatthefoundingoccurredonJuly4,1973,whentheTreatyofChaguaramaswassigned.ThetreatytransformedtheCaribbeanFreeTradeAssociationintoacommonmarket(Granma2018).Nonetheless,thetreatywastheoutcomeofa15-yearefforttofulfillahopeofregionalintegrationthatwasbornthroughtheestablishmentoftheBritishWestIndiesFederationin1958.TheFederationceasedoperationsin1962,butthateventmayberegardedastherealbeginningoftheCaribbeanCommunity.2

Barbados,Jamaica,Guyana,andTrinidadandTobagosignedtheTreatyofChaguaramas.EightotherCaribbeanterritoriesjoinedCARICOMsubsequently.TheBahamasbecamethe13thmemberstatein1983,butwasnotamemberofthecommonmarket.In1991,BritishVirginIslandsandTurksandCaicosIslandsbecameassociatemembersofCARICOM,followedbyAnguillain1999.CaymanIslandsbecamethefourthassociatemember,andBermudabecamethefifthassociatememberin2003.Surinamebecamethe14thmembereconomyoftheCaribbeanCommunityin1995.In2002,HaitiwasthefirstFrench-speakingCaribbeanstatetobecomeafullmemberofCARICOM.3

2“HistoryoftheCaribbeanCommunity,”CARICOM,Georgetown,

Guyana,

/history-of-the-caribbean-community/

.

3“HistoryoftheCaribbeanCommunity,”CARICOM,Georgetown,

Guyana,

/history-of-the-caribbean-community/

.

1.Introduction3

Table1SelectedDemographic,Geographic,andSocioeconomicIndicators:

CARICOM

Life

Mobilecellular

expectancy

Under-5

Primary

subscriptions,

Surface,

GNIper

atbirth,

mortality

completion

per100

Economy

Population

sq.km

capitaa

years

rateb

ratec

population

AntiguaandBarbuda

98,728

440

19,610

77.15

6.4

96.2

187.89

Bahamas,The

396,914

13,880

31,870

74.05

12.3

—

118.50

Barbados

287,708

430

14,530

79.31

12.2

96.04

102.65

Belize

404,915

22,970

6,600

74.75

11.7

104.46

66.39

Bermuda

63,867

4,290

87,340

82.06

—

91.57

109.19

BritishVirginIslands

30,423

150

—

—

—

98.12

116.31

CaymanIslands

66,498

264

53,770

—

—

89.55

152.16

Dominica

72,172

750

12,010

—

35.4

113.93

105.58

Guyana

790,329

214,970

23,480

70.02

28.4

—

108.83

Haiti

11,541,683

27,750

3,130

64.32

60.5

—

64.19

St.KittsandNevis

53,546

260

25,900

..

15

98.08

146.62

St.Lucia

184,401

620

13,810

76.34

24.4

100.36

110.55

St.Vincentandthe

Grenadines

111,269

390

13,950

72.66

14.1

104.91

87.49

Suriname

591,798

163,820

14,430

71.80

17.6

90.32

153.31

TrinidadandTobago

1,403,374

5,130

25,670

73.63

16.6

—

142.05

TurksandCaicosIslands

39,226

950

22,660

—

—

129.40

—

Caribbeansmallstates

7,481,631

434,990

—

—

—

—

112.89

Source:WorldBank.

Note:GNI=grossnationalincome.

a.CurrentinternationalUSdollars.

b.Totalper1,000livebirths.

c.Total,%ofrelevantage-group.

ThecaseofGuyanaisrevealing.Thecountryisexperiencingaperiodofexceptionalgrowthwiththedevelopmentoftheoilandgassector.Realgrossdomesticproduct(GDP)percapitaisexpectedtoreachUS$26,000by2024,morethandoublethe2020level,andtheshareoftheoilandgassectorisanticipatedtorisetoapproximately74percentoftotalGDP(WorldBank2022).

1.2.Theglobalburdenof

diseaseintheCaribbean

TheCaribbeanregionencompassesmorethan25countriesandterritoriesthatvaryinsize,geography,resources,andsurveillance

systems.Chronicnoncommunicablediseases(NCDs)representthegreatesthealth-relatedburdensintheregionandarethemostcommoncausesofdeath(Razzaghietal.2019).Figure1showstheproportionofthevariouscausesofdeathacrossCaribbeaneconomies.ItcanbeeasilyperceivedthatNCDsconstitutethemajormortalityburdeninalltheeconomiesincluded,whilecommunicable,maternal,andnutritionalconditionsrepresentasmallshare(around5percent–10percent).OnlyHaitistandsout:24percentofthecausesofdeaththereareassociatedwithcommunicable,maternal,andnutritionalconditions.

Haiti

Guyana

DominicanRepublic

Belize

SaintVincentandtheGrenadines

LAC32

Grenada

Suriname

SaintLucia

Jamaica

Dominica

Cuba

TrinidadandTobago

AntiguaandBarbuda

Barbados

Bahamas

80%

60%

40%

20%

0%

4TheCaribbeanRegulatorySystem:ASubregionalApproachforEfficientMedicineRegistrationandVigilance

Figure1TheproportionofallcausesofdeathindifferentCaribbeancountriesandtheoverallproportioninLatinAmericaandCaribbeancountries(LAC32)

InjuriesNCDCMN

Source:AdaptedfromOECDandWorldBank2020.

Note:CMN=communicable,maternal,andnutritionalconditions,includingperinatalconditions.

NCD=noncommunicablediseases.

ExceptforHaiti,demographicindicatorsontheCaribbeaneconomiesareconsistentwiththehealthoutcomesexpectedformiddle-incomeeconomies.ThisisalsolinkedtotheepidemiologicaltransitiontowardarisingprevalenceofNCDs,suchascardiovasculardisease,cerebrovasculardisease,diabetes,chronicrespiratorydiseases,andcancer.TheCaribbeanregionfacesthehighestburdenofNCDsamongemergingeconomiesintheAmericas.ChronicNCDsarelinkedtomorethan70percentofthedeathsintheregion(whichissimilartothecurrentglobalaverage).Ingeneral,NCDshavedirectandindirecteconomicimpactsonthefuturehealthsystemsandeconomiesoftheCaribbeanregion(WorldBank2013).

In2019,astudywasconductedtoidentifyNCDmortalitypatternsin20English-orDutch-speakingCaribbeancountriesorterritoriesandintwoterritoriesoftheUnitedStates(PuertoRicoand

theUSVirginIslands)(Razzaghietal.2019).Thestudyexaminedannualage-standardizedmortalityratesand10-yearmortalitytrends(2006–16)associatedwithcancer,heartdisease,cerebrovasculardiseaseorstroke,anddiabetes.ThesefourNCDsaccountedfor39percentto

67percentofalldeathsinthe22countriesandterritoriesandmorethanhalfofthedeathsin17oftheeconomies.HeartdiseaseaccountedforgreatersharesofdeathsamongmostoftheCaribbeancountriesandterritories(13percent–25percent),followedbycancer(8percent–25percent),diabetes(4percent–21percent),andcerebrovasculardisease(1percent–13percent)(box1).

Manyoftheseconditionsareinterrelated;thus,patientswithNCDsare,inmostcases,patientswithmultimorbidityandrequirethechronicuseofmultiplemedicines,therebydirectlyaffectingaccess,procurement,andthepossibleharmsderivedfrom

1.Introduction5

BoxOne

TheNoncommunicableDiseaseBurdenin

theCaribbeanExplainedinNumbers

.lutVeAmeJioes‘30percento}ellpeetVseJe

oeusepq(dJeveuteqleuouoommuuioeqlepiseeses)NOas(tVetooouJdJemetuJel()>LO(eeJs(.

.3u6lisV-sdee才iu6OeJiqqeeuoouutJieswitVe

doduletiouo}7.5million—mostl(A}JioeueupAsian-Indiandescent—aretheworstaffectedq(tVeNOaedipemioiutVeAmeJioes.

.aieqetes-JeleteploweJextJemit(emdutetious

iu日eJqeposeJeemou6tVehighestrecorded

woJlpwipe.

.OomdeJepwitVNoJtVAmeJioe‘pieqetes

moJtelit(is600percentVi6VeJiuTJiuipepeupToqe6o‘oeJpiovesouleJpiseesemoJtelit(isudto84percentVi6VeJ‘eupoeJvioeloeuoeJJeteseJe3-12timesVi6VeJ.

.WViletoqeooouseismopest‘oqesit(

eupoveJwei6Vtemou6}emelesexoeep50percent-60percentiumostoouutJies‘eupexoessiveelooVoluseoeusesmuoV

moJqipit(

eupmoJtelit(.

Source:Hospedalesetal.2011.

.OveJtVedestVel}-oeutuJ(‘V(deJteusiou‘

pieqetes‘eupoeJpiovesouleJpiseeseVeve

6Jowuexdoueutiell(:tVeeoouomioimdeot

o}V(deJteusioueuppieqetesVesqeeu

estimetepet5percent-8percento}tVe

6JosspomestiodJopuot.

.lutVeOeJiqqeeu‘oqesit(emou6oVilpJeueup

teeusqetweeuS-l6(eeJso}e6eooutiuuestoJisewVeJe1in3isoqeseeupetJis才o}pevelodiu6euou-oommuuioeqlepiseese‘wVioVwillimdeotVeeltVeupdJopuotivit(o}tVeoouutJiesiutVe}utuJe.OA\dHAooutiuuestopevelod6uipeuoeeupotVeJtoolstosuddoJttVesuqJe6iouelJesdousetodJeveutNOasiuoVilpJeu‘epolesoeutseupepults.

.WVileNOasooouJmoJe}Jebueutl(emou6

tVedooJqeoeuseo}6JeeteJexdosuJetoelooVol‘toqeooo‘eupuuVeeltV(piets‘tVe(VevelesseooesstodJeveutiveeupouJetiveseJvioes:tVeoosto}tVeilluessoJdJemetuJepeetVo}qJeepwiuueJsdusVestVeiJ}emilies}uJtVeJiutodoveJt(.

polypharmacyinalreadyfrailpatients.Withinthisframework,thecontinuoussurveillanceofthesafetyandeffectivenessofmedicines(thatis,pharma-covigilance[PV])isanoutstandingneedbecause,inadditiontotheburdenofNCDs,CARICOMeconomiesarecharacterizedbyethnicandracialgroupsthatarenotroutinelywellrepresentedinclinicaltrialsforthemedicinesthatareusedamongthepopulations.Hence,theneedforPVtoidentifyanyunexpectedor

previouslyunidentifiedsafetysignalsthatareuniquetothegivenracialandethnicgroups.

ThekeypointisthattheCaribbeaneconomiesaresmallandhavelimitedresources;so,theissuerevolvesaroundwhetheranindividualeconomypossessessufficientresourcestoestablishafullyfunctioningPVprogramorwhethertheremaybeanalternative,more-efficientsolution.

6TheCaribbeanRegulatorySystem:ASubregionalApproachforEfficientMedicineRegistrationandVigilance

2.TheCaribbeanPublicHealthAgency

TheCaribbeanPublicHealthAgency(CARPHA)isaCARICOMinstitution.ItisthesolepublichealthagencyofCARICOM.Itwascreatedaspartofanefforttoamalgamateanddeliverthefunctionsoffivepreviousregionalhealthinstitutionsin

2011s(CaribbeanEpidemiologyCentre,CaribbeanEnvironmentalHealthInstitute,CaribbeanFoodandNutritionInstitute,CaribbeanHealthResearchCouncil,andCaribbeanRegionalDrugTestingLaboratory)throughoneplatformforgreatersynergyandcost-effectivenessandastheprincipalinstitu-tionalexpressionofCaribbeanCooperationinHealth(Hospedales2019)(seefigure2).CARPHAhasreachedintergovernmentalagreementswith26membercountries/territories.Inaddition,partnerscontributeasignificantamounttothefundingofCARPHA,exemplifyingapracticalwayofSouth-South-Northcooperation(Hospedades2019).Inthefinancialyear2022-2023,theproportionwas62percentfrompartnersand38percentfrommemberstates.TheEU,theUSA,theUK,Canada,France,Germany,theNetherlands,andLatinAmericancountrieshaveparticularlyintertwinedinterestsintheCaribbean.

2.1.CARICOMgoverningbodies

CARICOM’sprincipalgoverningbodiesaretheConferenceofHeadsofGovernmentandtheCouncilofForeignMinisters.Theconferenceisthehighestauthorityoftheregionalorganizationandincludestheheadsofstateandgovernmentadministrationsofmembereconomies.Itisresponsibleforestablish-ingpolicyandauthorizingthesignatureoftreatieswithintheCaribbeanCommunityandwithotherintegrationorganizations.

Thecounciliscomposedofforeignministersandisresponsibleforimplementingstrategicplans,coordinatingsectoralintegration,andpromotingcooperationamongmembers.Oneoftherelevantsectorsishealth.

2.2.TheCaribbeanCooperationinHealth

TheCaribbeanCooperationinHealth(CCH)advancestheCARICOMobjectiveofenhancedfunctionalcooperationinhealthinstitutedintheRevisedTreatyofChaguaramas,Article6.Itisintendedtosupportthemore-efficientoperationofcommonservicesandactivities,promotegreaterunderstandingamongpeoplesandprogressinsocial,cultural,andtechnologicaldevelopment,andintensifyjointactivitiesinareassuchashealthcare,education,transportation,andtelecommunications(CARICOMandCARPHA2018).

CCHrepresentsthegoverningphilosophyin

healthinCARICOM.TheCCHregionalframeworkseekstoenhancefunctionalcooperationinhealthamongCARICOMmembers,regionalinstitutions,anddevelopmentpartners.Sinceitsfoundationin1984andwitheachsuccessiveiteration,CCHhaspromotedefficiencyinaddressingtheregion’ssharedhealthanddevelopmentchallenges.ThefourthphaseofCCH,CCHIV(2016–25),emphasizesmultisectoralcollaborationandregionalpublicgoods(CARICOMandCARPHA2018).

TheCCHSecretariatworkscloselywithCARPHAtoadvancetheimplementationofCCHIV.AnactionplanwasdevelopedtostrengthenthecapacityofCARICOMmemberstocollectandreportonhealthindicators(CARICOM2021).Therearefivestrategicpriorityareas,asfollows:

?Healthsystemsforuniversalaccesstohealthanduniversalhealthcoverage

?Safe,resilient,andhealthyenvironments

?Thehealthandwell-beingofCaribbeanpeoples

?Dataandevidencefordecision-makingandaccountability

?Partnershipandresourcemobilizationinhealth

CRDTL

16L4

CAREC

16L5

CHRC

1655

CFNI

169L

2.TheCaribbeanPublicHealthAgency7

Figure2RegionalHealthInstitutionsMergedintheCaribbeanPublicHealth

Agency,2013

CEHI

16L2

CARPHA

Source:CARPHA.

Note:CAREC=CaribbeanEpidemiologyCenter.CEHI=CaribbeanEnvironmentalHealthInstitute.CFNI=CaribbeanFoodandNutritionInstitute.CHRC=CaribbeanHealthResearchCouncil.CRDTL=CaribbeanRegionalDrugTestingLaboratory.

TheactionplanalsostrengthensthecapacityoftheCCHSecretariatandCARICOMmemberstoimplement,monitor,andreportonregionalpublicgoods.InNovember2021,strategiesandactionstoaddresstheseareaswereendorsed.Theyincludedthedevelopmentofathree-yearactionplanwithcostingsandafinancing/resourcemobilizationstrategyandmechanisms.Chiefmedicalofficersandothertechnicalexpertspreparedthestrategiesandactions(CARICOM2021).

Theseactivitiesarepossiblebecausethecommunityhasestablishedbasicinstitutionswithspecializedfunctionsthatcontributetotheachievementoftheobjectives.OneoftheseinstitutionsisCARPHA.

2.3.ThecreationoftheCaribbeanPublicHealthAgency

CARPHAwas